A Pilot Study of Nebulized Heparin for Prevention of Ventilator Induced Lung Injury: Comparative Effects with an Inhaled Corticosteroid.

BACKGROUND

Ventilator-induced lung injury (VILI) is a side effect of mechanical ventilation. Lung inflammation and pulmonary activation of coagulation are induced by mechanical stress. Clinical and preclinical studies show that heparin possesses anti-inflammatory properties. Therefore, we assessed the effects of nebulized heparin in VILI.

METHODS

Sixty critically ill adult patients who require mechanical ventilation for more than 48 h were included in this prospective, nonrandomized controlled study. Patients received nebulized heparin (10,000 U every 6 h) for 5 days. The matched control group received nebulized budesonide as routine practice in our center. This study assessed changes in partial pressure of oxygen to inspired fraction of oxygen ratio (PaO/FiO) and rapid shallow breathing index (RSBI) during the study as primary endpoints.

RESULTS

The average daily PaO/FiO ratio was not statistically significant between both groups (187 ± 11.6 vs. 171 ± 11.6, = 0.35). The RSBI also did not differ between groups ( = 0.58). Heparin administration was associated with a higher number of ventilator-free days among survivors but not significantly (7.7 ± 10.6 vs. 5.1 ± 8, 95% confidence interval - 2.2-7.5, = 0.28). Successful weaning from mechanical ventilation was higher in the heparin group ( = 0.42). We did not observe any serious or increased adverse effects from nebulized heparin.

CONCLUSION

The results of this study show that the overall effectiveness of nebulized heparin is at least as comparable with a potent corticosteroid (budesonide). Heparin could be a safe and effective modality for patients who at risk of VILI.